Talking about cognitive decline

It might be the most important conversation you have

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Dementia can be an extremely difficult topic to discuss, both for the one facing cognitive decline and for family or friends. However, these conversations can be some of the most important to have. How can families discuss cognitive impairment in sensitive and productive ways?

Planning ahead

Typically, the most productive time to begin planning is before the onset of cognitive decline. These conversations can become very emotional, and some people resist having them because it often revolves around the prospect of losing and ceding control. However, planning conversations actually allow people to maintain control by putting in place documents that ensure their wishes are followed later on, even if their decision-making facilities become impaired. Take this opportunity to talk about how they envision a comfortable later life. Let the talks be about shaping one’s later years and legacy.

In some scenarios, the person facing cognitive decline may want to remain private about their financial resources. When this is the case, it’s important for family members to make it clear that the discussion is not about the balance of an account but about understanding what needs to be done to ensure their wishes are carried out responsibly. If there are documents already in place, make sure to keep them updated. Legal documents drafted years ago may not be suitable anymore as family dynamics may have changed.

Although most people have wills and trusts, Powers of Attorney are seen as ancillary and may be neglected. Powers of Attorney, including health care power and advanced health care directives, are important because they can speak for the afflicted when they may no longer have a voice or their voice does not make sense. This helps the person in cognitive decline and helps loved ones who may need to make hard decisions.

The significance of [planning] documents is that you can let loved ones know what you want. You can’t relieve their grief, but you can relieve their guilt over not knowing if they made the right decision.
Christine Kolm
Senior Wealth Strategist, UBS Advanced Planning Group

When there are signs of cognitive decline

While planning ahead is prudent, it’s not always an option. What happens if a loved one is already exhibiting signs of dementia? This too is a difficult conversation. Both the subject and their loved ones may not want to acknowledge a change in cognitive abilities.

Some guidance from the Alzheimer’s Society include:

  • Pick a place that is familiar and non-threatening to bring up the topic
  • Choose words carefully—use reassuring and non-judgmental language
  • Ask the subject if they have noticed any changes in themselves
  • If appropriate, mention things you’ve noticed, but do so in a way that shows concern
  • Listen and give the person time to process—this topic may have come as a shock
  • Encourage the person to see a doctor

In some cases, especially if there are challenging family dynamics, it can help to have an outsider like a doctor facilitate a discussion. And oftentimes it can be even more helpful if the conversation is guided by a third party who has had a long relationship with the subject, like a long-time family physician (or when appropriate, a trusted financial advisor or lawyer) whom the person knows has their best interest at heart.

Caring for caretakers

As illness progresses, communication among caregivers is extremely important. Check in with regular frequency on how each person is handling their role. Set aside time for family meetings focused on taking care of the person in cognitive decline and taking care of each other.

As challenging as these scenarios can be, open communication and advanced planning can provide a path forward for those facing cognitive decline as well as their loved ones.

Want to know more? Click here to listen(MP3, 8 MB) to Christine Kolm, Senior Wealth Strategist, UBS Advance Planning Group, discuss on a UBS podcast how to financially prepare for complications surrounding cognitive decline. Special thanks to the UBS Family Advisory and Philanthropy team for their insights informing this article.

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